First, do no harm

LONDON (AP) - Family doctor Harold Shipman, Britain's worst serial killer,
murdered 215 of his patients in 23 years as a trusted small-town practitioner, a
public inquiry reported Friday.

The inquiry's head, High Court Judge Dame Janet
Smith, said there was also a suspicion Shipman had
killed 45 more people between 1975 and 1998.

Smith said she had "no clear conclusion" about
Shipman's motive. In only one case was there
evidence that he killed for money, and there was "no
suggestion of any form of sexual depravity," she said.

"It is possible that he was addicted to killing," the
judge said.

Some victims' relatives said they didn't think they'd
ever know what motivated him.

"It's the eternal question — Why? Why did he do it?"
said Jane Ashton-Hibbert, whose 81-year-old
grandmother was among the doctor's victims.
"There's been far too many questions and not enough
answers."

Shipman, 56, was convicted in January 2000 of murdering 15 of his patients —
all elderly women — by injecting them with heroin. But police said then that he
may have killed scores more. He is already serving 15 life sentences with no
possibility of parole, and prosecutors have ruled out further trials.

Shipman maintained his innocence, and no motive has been established for the
crimes of which he was convicted.

He was liked and admired by those who new him in Hyde, a small community
in northern England.

"I personally can't reconcile the doctor that I knew that came to deliver my
sister, looked after me when I had my daughter, with the doctor that I know
now," Ashton-Hibbert said. "I think that's the hardest thing, ... the betrayal of
trust."

Smith's yearlong inquiry has investigated the deaths of 494 of Shipman's
patients between 1974 and 1998. It found that at least 215 of them were killed
by Shipman, most of them by lethal injection.

"The true number is far greater and cannot be counted," Smith said. She said in
45 more cases there was strong but inconclusive evidence Shipman had killed
the victims. Investigators found too little evidence to determine if the deaths of
38 others were natural or not.

In her interim report Friday, Smith said Shipman began his killing spree in 1975,
a year after he entered practice. His victims, ranging in age from 41 to 93,
included 171 women and 44 men.

"He betrayed their trust in a way and to an extent that I believe is unparalleled
in history," Smith said.

For more than 20 years Shipman was a respected member of the community in
Hyde, a working-class town of 22,000 just outside Manchester in northwest
England. In 1992, he set up a practice in the town. Between then and 1998 he
killed 143 people, Smith concluded in her 2,000-page report.

But his activities did not arouse suspicion until March 1998, when another
doctor, who had been asked by Shipman to cosign some cremation
certificates, expressed concern at the number of deaths. Police concluded
there wasn't enough evidence to pursue charges.

The investigation was reopened months later after the daughter of an
81-year-old widow discovered that her mother apparently had changed her will
to leave everything to Shipman. That led to exhumations and eventually to
Shipman's trial and conviction.

A jury found that he deliberately injected heroin into 15 elderly women — many
in good health — during routine checkups in their homes or at his office,
falsifying computer records to create fictitious symptoms to explain their
deaths.

Peter Wagstaff, whose mother was killed by Shipman, said he didn't think the
doctor's motivation would ever come to light.

"I don't think I've met anybody yet that's ever said they hate him, because I
don't think they understand the situation," Wagstaff told a news conference.
"You can't make sense of it all, you can't come to the right terminology to say
what you think of him."

The inquiry will now consider how Shipman was able to escape detection for so
long. Smith said it would attempt to come up with improved safeguards "so as
to ensure such a terrible betrayal of trust by a family doctor can never happen
again."